Bone pocket of the tooth. Cleaning gum pockets. Gingival pocket - inflammation: causes, treatment

A gingival pocket is a depression between the gum and the tooth. A recess of up to 3 mm is considered normal. Anything deeper is a problem that can lead to serious consequences up to the loss of a tooth. The main trouble with such a pocket is that food debris constantly collects in it and needs to be cleaned regularly until it heals.

How to remove the problem of the gum pocket?

If you have a pocket between the gum and the tooth, it is better to go to the dentist immediately and without delay. However, there are also reliable folk methods treatment for this problem.

Gingival pocket - storage for germs and bacteria

Here are some medicines you can make at home:

Mix 1 tbsp. l. green peel walnuts and 250 warmed olive oil. Put the mixture in the refrigerator for a week, shake the jar daily. Lubricate the gum with medicine 5 times a day.
2 tsp eucalyptus oil dilute in a glass of boiling water, let cool slightly. Rinse your mouth 3 times a day.
1 tsp grated beet put in cheesecloth, but do not squeeze the juice. Apply the compress to the gum for 15 minutes. Repeat thrice daily with fresh compresses.
1 st. l. knotweed, pour 250 ml of boiling water. Let it brew for 15 minutes. Soak a cotton pad in the tincture and apply to the gums for 10 minutes. Repeat morning and evening, warm the infusion before use.

Whatever tool you choose, use it regularly, otherwise you will not be able to solve the problem.

How to clean the gum pocket yourself and how to do it in the hospital?

It is very difficult to completely clean the gum pocket on your own. All you can do at home is to monitor his hygiene and maintain it. For this you need to use toothbrush with abrasive toothpaste, dental floss and rinse your mouth regularly after every meal and snack.

In the hospital, the gum pocket is cleaned in two ways:

private method. Suitable for shallow pockets up to 5 mm. For cleaning, a special apparatus with ultrasound or laser is used. This method is simple, fast and painless.
public method. Suitable for pockets with a depth of more than 5 mm. This is a full-fledged surgical operation that takes place under anesthesia. The doctor cuts the gum, cleans the debris, applies the drug, and stitches the gum.

If you don't want to have dental surgery, don't let the problem get to that extent.

Treatment of a pocket near the gums - compulsory procedure. You can be treated at home using the methods described above. In this case, pay close attention to hygiene oral cavity. If the pocket does not disappear, be sure to visit the dentist.

Some diseases of the oral cavity require a special approach. Often drug treatment is not enough, it is necessary to eliminate the cause of the disease and get rid of its consequences. One of the clearest examples inflammatory process affecting the jaw bones and even the ligaments that can hold the crown in place is periodontitis.

Curettage of the tooth socket will help to cure such a disease. With the help of this procedure, carried out by an open or closed method, the doctor will be able to remove the accumulated plaque and stone with a curette and an irrigator, as well as clean the wells from the waste products of bacteria and viruses.

Periodontal pockets - what is it?

Over time, tartar is deposited, its accumulation can lead to the development of an inflammatory process in periodontal tissues and their further destruction, affecting bone tissue. As a result of inflammation, a depression is formed, starting from the gum and ending with the cervical part of the crown, called the "periodontal pocket".

Depending on the depth and width of the pocket between the teeth, the doctor will be able to determine the extent of the disease. An early stage can be diagnosed with an X-ray examination, and if the inflammation progresses, it can be determined visually. Normally, the recess should not exceed 3 mm - if the gum pocket goes beyond the specified limits, this indicates the presence of a dental disease.

Curettage of the gingival pocket in dentistry

Curettage is medical term meaning cleansing of body cavities, organs or skin using a special instrument called a curette. With the help of this surgical procedure, the doctor removes the affected areas and cleans the areas of accumulation pathogenic microorganisms. Also, the curette will help to produce diagnostic curettage, in order to subsequently transmit the received biological material for laboratory research.

Well curettage is one of the most common medical procedures carried out in the treatment of periodontitis that occurred after tooth extraction. During the procedure, the dentist removes purulent neoplasms, tartar located under the gum, and areas of the destroyed tooth.

Indications for the procedure

A patient at a dentist's appointment may be recommended curettage of periodontal pockets in case of:

Curettage of periodontal pockets is a completely different procedure than cleaning the enamel, in which only plaque is removed. Cleaning the tooth pocket allows you to get rid of accumulated deposits, and also prevents further decay of tissues.

When is treatment contraindicated?

The operation should be abandoned if there are purulent discharge, there is a high probability of developing an abscess, or the gum pocket has spread to bone structures. If the depth of the periodontal pocket is more than 5 mm, the gums are too thin, there are fibrotic changes, or tooth mobility reaches grade 3, then the doctor will refuse to perform this surgical procedure. Also, the procedure for curettage of the hole, in order to avoid complications, cannot be sent if there is acute infection in the oral cavity or with impaired physiological functions.

Pros and cons of curettage

There are several positive and negative aspects procedures such as curettage. The advantages of this procedure include:

Unfortunately, there are also disadvantages. Concerning private method, then in advanced stages Periodontitis almost always relapses. Another disadvantage is the duration of the procedure. The patient during the open curettage on 6-7 teeth will have to spend about two hours.

The open method requires the utmost concentration and care from the surgeon. An unqualified doctor can injure the mucous membrane and teeth.

Procedure procedure

Translated from of English language"curettage" is nothing more than "curettage". In dentistry, the meaning of this term is much broader. When conducting scraping for the treatment of gum disease, doctors adhere to the following tactics:

the place of the procedure is treated with an antiseptic solution;
anesthesia is administered;
plaque and calculus are removed from the surface of the teeth (as seen in the photo) using a periodontal irrigator;
the affected area of cement and dentin is removed from the root of the tooth with scraping movements;
the root of the tooth is leveled and polished;
tissue damaged by the infection is eliminated;
an antiseptic agent is applied to the cleaned tissues;
a fixing bandage is applied to the gum pressed against the tooth.

After a correctly performed operation, shown in the video, blood circulation and lymph flow are restored in the gingival canal. Thus, all conditions are created for the speedy regeneration of tissues.

Closed

A distinctive feature of the closed method of treating periodontal pockets is the inability to visually track the condition of the tooth roots, so granulation and tartar can remain intact. The effect of the procedure is possible if the depth of the periodontal pocket is not more than 3 mm. With periodontitis, only temporary relief is possible, the disease itself will continue to progress.

A doctor in one procedure of closed curettage of periodontal pockets can clean the cavity of 2-3 teeth, after the procedure, the healing process can take up to a week. Diagnosis can be carried out no earlier than a month after dental intervention. Usually, gum curettage is used only in those dental clinics where there are no highly qualified specialists, and the procedure is performed not by an experienced surgeon, but by a dentist therapist.

Open

Open curettage allows you to remove all existing subgingival deposits and damaged tissue in the area of one tooth, synthetic bone tissue is implanted, and during the treatment, the gum pocket disappears. Open curettage is performed under local anesthesia.

In the process of laser curettage, the surgeon makes an incision in the area of the necks of the tooth, and then exfoliates the gum. The doctor is able to detect all existing subgingival deposits, so that later such treatment allows them to be removed using a curette or irrigator. The area where the operation is performed must be treated with an antiseptic. If the bone pocket is deep, then the doctor uses a synthetic material for extension.

At the end of the operation, the doctor applies stitches, which must be removed after ten days. In the process of laser surgery, it is possible to dissect tissues without contact, minimize pain and instantly coagulate blood vessels. Restoration of gingival papillae postoperative period happens faster.

Curettage and flap surgery on the gums

Application patchwork operation inflammation of the gums leads to good results. During the operation, the surgeon has good visual control, so all affected areas are removed. This surgical intervention involves cutting out the periosteal surface of the periodontium, including the processing of root and soft tissues.

Complications are possible in the postoperative period. The necks of the teeth may be exposed, or changes in the alveolar processes will occur. Aesthetic defects or the occurrence of dentinal hypertension are also possible.

Is it possible to carry out treatment at home?

If the periodontal period hurts, self-medication at home means deliberately taking risks. Periodontal disease is serious illness requiring medical supervision.

Help at home various methods, which will be combined with therapy prescribed by an experienced periodontist. For example, gum sockets can be treated using various ointments and gels that can improve metabolism and blood circulation in tissues.

Folk remedies for periodontal pocket disease can also help if we are talking about initial stage diseases. Solutions and decoctions help well medicinal plants with antimicrobial and wound-healing effect, they can rinse your mouth.

Possible Complications

If the curettage of periodontal canals is carried out by an experienced doctor and strictly adheres to the methodology for its implementation, then complications can be avoided. However, there are cases when, due to a certain set of circumstances, complications arose:

profuse blood loss;
inflammation in the postoperative period;
secondary infection.

If the doctor is not experienced enough in performing such operations, or the work was done carelessly during the operation, then not all pathogenic tissues will be removed from the periodontal pocket. In this case, the likelihood of relapse is high. The patient needs to re-apply for help to a specialist who is able to perform high-quality cleaning of periodontal cavities.

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Development of the pathological process

Normally, the pocket in the gum is deepened by no more than 3 mm. The small depth of the neck formed from soft tissues does not prevent its self-cleaning. Progressive deepening and inflammation of the gum pockets - characteristic symptom periodontal disease. The gum between the teeth swells, begins to hurt, and pus may appear from it. The initial stage of the development of the disease is gingivitis. At this stage, remove inflammatory phenomena quite easy - you need to carefully monitor oral hygiene, regularly undergo professional teeth cleaning with the removal of soft and hard plaque, rinse your mouth with antiseptics and herbal infusions.

Further development of the inflammatory process is accompanied by a significant increase in the number of bacteria. The enzymes secreted by them negatively affect the periodontal fibers, gradually causing their destruction. At this stage gum pockets undergo a series of changes and become periodontal. The activity of the inflammatory process increases, affected by it soft tissues when touched, they bleed, erosion occurs on the gums.

The cavity between the tooth and gum becomes deeper, connective tissues, which ensure the integrity of the dentition, are affected by inflammation and weaken.

In the absence of treatment and cleaning of the gum pockets, the process will spread not only to the fibers of the periodontal ligaments, but also to the jaw bone tissue.

Receding gums lead to gradual exposure of the tooth. Destroyed tissues are not able to secure the top of the root in the hole and at some point it falls out.

At the initial stage of the disease, pockets in the gums are washed with an antibacterial agent once a year. Additionally, daily application of drugs to the affected areas, rinsing the mouth is prescribed. medicinal formulations. With periodontitis moderate effective method of curettage severe course diseases are used photodynamic, surgical methods and cable-stayed.

Types of curettage, indications for the procedure

There are open and closed types of curettage. This technique provides effective removal tartar, food debris, affected gum tissue and softened dental cement. For closed curettage, use diode laser or ultrasonic scaler. This method of treating pockets in the gums is used in cases where the depth of the cavity surrounding the tooth does not exceed 5 mm. The deepening is cleaned, the tooth root is processed and polished, the affected tissues are removed. This helps to restore the connection between teeth and gums.

Open curettage is surgical intervention using local anesthesia. During the operation, the tissue in the area of the interdental papillae is dissected, the tartar is removed, the gingival pocket is thoroughly cleaned of deposits. Then a drug is applied that accelerates the growth of the epithelium and suppresses the vital activity of pathogenic microbes. The tooth root is polished for a tighter fit of the mucous membrane to it, and the wound is sutured. rehabilitation period after the procedure is two weeks, after its expiration, patients note positive results- the gum does not bleed, does not hurt, hyperemia and swelling go away, the depth of the pocket decreases.

Indications for curettage are:

the depth of the pocket of exfoliated gingival tissue exceeds 3 mm;
accumulated a large number of solid deposits;
the gum is affected by the inflammatory process.

Photodynamic method

Non-surgical treatment of neglected or severe form periodontal disease can be photodynamic therapy. Before the procedure is performed professional cleaning oral cavity, after which the gums are treated with chlorophyll obtained from spirulina algae. In response to its application, epithelial cells begin to produce photosensitizer substances. After 30 minutes, the doctor directs to the diseased tissue laser ray. Its radiation leads to the decay of photosensitizers with the release of active oxygen.

Under the influence of the oxidative process, the microbes that caused inflammation are completely destroyed. The doctor removes damaged areas of tissue and closes the gum pocket. The advantage of this treatment method: sparing painless effect and high efficiency- a single procedure is enough to eliminate inflammation and bleeding. A film is formed on the gums that prevents the penetration of infection and the recurrence of the disease. The use of osteogenic preparations and amino acids helps to restore the affected tissues.

With a periodontal pocket depth of more than 4–5 mm, a patchwork method is used. During the operation, the gum is separated from the surface of the tooth, the contents of the pocket are removed, the cleaned cavity and root are treated with an antiseptic. The soft tissues of the gums are then fixed in the correct position with sutures. In most cases, the method gives positive results. Its disadvantages include the stress experienced by the patient and a long recovery period.

Cable-stayed splinting

This method of treatment allows you to strengthen teeth that have begun to loosen. Splinting technology consists in tying the moving units of the dentition with aramid thread, which is particularly durable. Thin grooves are drilled along the perimeter of adjacent teeth, after laying the thread is covered with a reflective material. The color of the filling matches the shade of the teeth, so it is almost invisible.

The cable-stayed splinting method prevents the loosening of the dentition, while at the same time ensuring the natural mobility of the teeth, preventing the jaw bones from atrophying. Fastening with aramid thread does not disturb diction and does not cause discomfort in the patient. To restore the voids of the dentition in place of lost teeth, it is advisable to use prostheses not made of metal-ceramic, but combining ceramics and glass or titanium, so as not to overload the jaw.

At the initial stage of periodontal disease, preparations made from herbal ingredients according to the recipes of traditional medicine. They inhibit bacteria and improve wound healing. Additionally, it is useful to massage the gums with a soft-bristled toothbrush, followed by rinsing the mouth with infusions of chamomile, oak bark or sage.

A good therapeutic effect is provided by the following means:

Peel of unripe walnuts, infused with olive oil(1 tablespoon per 250 ml). For infusion, the mixture should be placed in the refrigerator. Periodically you need to get a jar and shake it. After a week, strain and use to lubricate the gums 3-5 times a day.
Infusion or juice of plantain. To prepare the infusion, pour 20 g of leaves with a glass of boiling water. Use for mouthwash. squeezed out fresh leaves plant juice is applied to the diseased areas of the gums 3 times a day.
Compresses from grated fresh beets. The mass, without squeezing, is wrapped in gauze and kept on the gum for 15 minutes. Frequency of use - 3 times a day.
Infusion of grass highlander kidney. Pour a spoonful of crushed vegetative parts of the plant with a glass of boiling water. Let it brew for 15 min. Use 2 times a day, applying tampons moistened with warm infusion to the gums.
Gruel from crushed sea buckthorn berries. Wrap the mass of fruits in a two-layer piece of gauze and apply to diseased areas 2 times a day for 20 minutes.
Tincture of viburnum fruits with honey. It is necessary to mix 500 g of berries with the same amount of buckwheat honey and 500 ml of 70% ethyl (medical) alcohol. Put in a dark place for 2 weeks. How to use: 1 tbsp. l. 3-4 times a day for 20 minutes. before meals. Taking the remedy helps to strengthen the immune system and cure periodontal disease. Additionally, cotton swabs moistened with tincture can be applied to the gums.

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What is a periodontal pocket?

The accumulation of a large amount of deposits leads to development of inflammation in periodontal tissues. As a result of this process, there is a gradual destruction of periodontal and bone tissue. The simultaneous decay process leads to the formation of a periodontal pocket.

By the width and depth of the gap formed, one can judge the degree of tissue destruction. On the early stages gum pocket can be diagnosed using an x-ray. Progressive inflammation reveals the presence of pockets on visual inspection.

Symptoms

Formation of gum pockets may be asymptomatic up to a certain point. But with the development of the disease, its main symptoms also appear:

discomfort in the gum area;
bad breath that does not disappear after high-quality cleaning and the use of rinses;
redness and swelling of the gums. In this case, soft tissues have a shiny surface;
bleeding, even with little impact on the gums. For example, when cleaning crowns;
on palpation of periodontal tissues, soreness and pronounced suppleness of the gums are noted;
in advanced cases, the size of the periodontal pocket increases. When pressed, there may be a release of purulent contents;
teeth become mobile;
expanding interdental spaces;
a general deterioration in the patient's condition is possible.

When these symptoms are detected you should contact your dentist immediately, even if the problem is localized only near one tooth, otherwise the situation will worsen every day and lead to the progression of the disease.

Reasons for education

The main cause of periodontal pockets is accumulation of bacterial deposits in the cervical region of the crown. Microbes form an invisible film over the entire surface of the enamel and secrete their metabolic products, which cause inflammation.

The main factors that provoke the growth of microbes include:

malnutrition, mainly carbohydrate foods;
poor quality of oral hygiene;
bad habits;
general diseases;
hormonal disorders;
immunodeficiency;
dental diseases.

Consequences of the disease

A gum pocket is not just a periodontal deformity. it serious pathology requiring adequate and timely treatment, the absence of which can lead to serious complications.

Most often there is an acute abscess, later acquiring a chronic form.

This pathology is accompanied by strong tooth mobility and soreness. In the absence of proper treatment, the tooth completely falls out of the alveolar socket. The development of inflammation leads to lymphadenitis and general intoxication organism.

What treatments are available

Before the treatment procedure, a diagnosis is made, which determines the degree of the disease. This stage is necessary in order to select the maximum correct method to eliminate pathology.

On the initial stage use conservative therapy aimed at relieving symptoms. In difficult cases, the most effective is recommended - surgical method treatment of a periodontal pocket, which ensures the removal of plaque completely.

Therapeutic methods for eliminating the periodontal pocket

This method of treatment can be used with a small recess of the pocket, not exceeding 0.15 mm. In this case, on the subgingival part of the tooth should be minimal amount deposits and no signs of soft tissue inflammation.

Therapeutic treatment includes the following procedures:

Hygienic cleaning of teeth with an ultrasonic scaler. Removal of stone and plaque occurs by its destruction, without damaging the gums. This method in recent times more popular than laser curettage, where the affected area is treated with a laser to treat a periodontal pocket.

Medical therapy. As a rule, it is prescribed immediately after the completion of dental cleaning. At mild degree disease is used only aseptic processing: rinsing, baths, irrigation. To do this, use Chlorhexidine or Miramistin.

AT severe cases need to take a course of antibiotics Lincomycin, Amoxocillin, Azithromycin.

These procedures may be useless if the pocket depth exceeds 2 mm. In such a situation, the doctor will not be able to completely remove the stone from under the gums. In addition, the periodontium is additionally injured. As a result of the manipulations, inflammation and tissue destruction only intensifies.

Surgery

Surgical method of treatment provides for direct mechanical action with special tools on the subgingival areas. Depending on the degree of damage, there are two surgical methods for eliminating this problem: closed and open curettage.

The elimination of periodontal pockets by surgical methods is currently considered the most effective. After treatment with this method, the patient is guaranteed a positive result with complete restoration of the periodontium. But it should be borne in mind that each method has its own specific indications and features.

Closed operation

The purpose of closed-type curettage is to remove the growing granulation tissue of periodontal pockets and eliminate all deposits on the tooth under the gum.

The peculiarity of the method is that the procedure for cleaning the cavity is carried out without violating the integrity of the gums.

The main factor in choosing closed curettage is cavity depth not more than 3 mm. Therefore, the method is used only for mild form periodontitis.

With more complex forms of pathology, this method will bring only temporary relief. The main disadvantage of this technique is that cleaning is carried out without visual control. From what deposits and granulations partially remain in place.

Operation steps

Local anesthesia.
After that, the pocket cavity is cleaned with a curette. First, the walls of the tooth and gums are processed, then the bottom.
After complete removal of the stone and granulation, the pocket is irrigated with a solution of sodium chloride.
Finally, a protective dressing is applied to the treated segment. For this, zincoplast, stomalgin, repin are used.

Vacuum curettage

If present under the gum large cluster plaque, can be used alternative method– vacuum curettage. Its main difference from the classical method is that the procedure uses hollow curettes attached to a vacuum apparatus.

During clipping of pathological particles, they are immediately removed by vacuum. Thus, the occurrence of further complications is excluded.

open procedure

main goal this method is not only the elimination of granulation and deposits, but also the restoration of bone tissue.

With open curettage, the effect on tissues is carried out by exfoliating part of the mucosa. Therefore, this procedure requires detailed preparation, which consists in the following:

Performing dental cleanings.
If necessary, prescribe anti-inflammatory therapy.
According to the indications, splinting is performed.

How is the operation

A small mucosal flap is exfoliated from the bone after cutting the tissue in the region of the necks of the teeth. In case of severe deformation of the gum edge, the incision is made, stepping back from the edge by 1.5 mm. The remaining strip is subsequently removed.
After exposing the surface of the roots, the doctor performs a deep cleaning.
Next, an osteogenic preparation is injected into the gum pockets, which compensates for the bone tissue.
At the end of the procedure, suturing is performed in the area of the interdental papillae. With a cut edge of the deformed gum, the mucosa is pulled up to the necks and fixed in this position. Sutures are usually removed on the 10th day after surgery.
To consolidate the effect, a gum bandage is applied.

Often, with the formation of deep periodontal pockets, there is a significant exposure of the roots. In order to eliminate this defect in the process of open curettage, soft tissue transplantation is performed, transplanting tissues from the soft palate onto the gum.

Contraindications

This technique It is considered the most effective, but it has certain contraindications:

abscess in acute form;
fibrous tissue growths;
excessive thinning of the gums;
strong mobility of the crown;
pocket depth exceeding 6 mm.

The price of all types of operations

The average cost of services for the treatment of periodontal pockets in Russia has a slight difference. The main factors that affect pricing are the method of anesthesia and the technological capabilities of the clinic. Not the last aspect will be the status of the clinic.

Average, the price range for closed curettage is in the range of 5000–12000 rubles. The procedure using open curettage will cost 9,000–18,000 rubles.

As practice shows, the most effective method to eliminate pockets in moderate and severe periodontitis, is open curettage. This technique allows not only to eliminate growths and damaged elements, but also to completely restore the lost bone over time.

The downside of this method can only be called a long healing process. In contrast, closed curettage is bloodless and less painful. But, unfortunately, it can be used only at the initial stage of the disease.

Patient reviews

Most patients undergoing periodontal pocket treatment are of the opinion that surgical method - the only way, which is guaranteed to eliminate the problem.

Reviews show that therapeutic treatment most often does not give results, only temporarily stopping the symptoms of the disease. If you have encountered similar pathology, and have experience in its treatment, you can leave your feedback in the comments to this article.

We offer you to watch a video about the process of performing the operation "open curettage of periodontal pockets":

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The structure of periodontal pockets and the stage of the disease

Periodontal pockets appear with gum disease - periodontitis, periodontal disease and gingivitis. Due to inflammation, the integrity of soft tissues is violated, they begin to “depart” from the enamel, gradually the necks of the teeth are exposed, and atrophy of the alveolar bone occurs.

Only periodontitis is accompanied simultaneously infectious inflammation and tooth mobility. With periodontal disease, the destruction of connective tissues occurs without the formation of pus, and with gingivitis, the integrity of the dentition is preserved.

Periodontitis creates an ideal environment for the reproduction of microbes and bacteria. The bottom is filled with food particles, plaque and pus. The patient cannot fully clean the pocket on his own. Over time, the process is aggravated: the space is filled deeper and deeper with solid deposits, and granulation tissue and alveolar processes atrophy.

Important! The main methods for examining gum pockets are radiography and probing. The picture clearly shows dark areas in the place where the soft tissues move away from the tooth.

There are three stages of the disease:

Light. The pocket depth is up to 3.5 mm.
Average. Destruction reaches 4 mm.
Heavy. Lesions exceed 5 mm.

Causes and symptoms

The main factor leading to the formation of periodontal pockets is the accumulation of bacteria and plaque, which literally rushes to the surface of the enamel. The reasons for the development of pathology include:

Poor or improper oral hygiene.
The use of large amounts of soft and carbohydrate food: sweets, pastries, fast foods.
Lack of solid vegetables and fruits in the diet: hard food helps to get rid of plaque, promotes proper blood supply to the gums and teeth strength.
Bite defects: crowding, curvature of teeth.
Diabetes.
Hormonal disbalance.
Immunodeficiency.
Poor-quality or incorrectly made fillings, crowns, bridges, prostheses.

Important! Smokers are the most susceptible to plaque formation on their teeth. Nicotine resins coat the surface of the enamel, especially with inside. For patients with addiction mandatory professional cleaning to avoid the risk of developing periodontitis.

The formation of periodontal pockets is accompanied by:

Itching in the gums.
Bleeding under mechanical impact.
Bad breath that does not disappear even after brushing and rinsing with solutions.
Separation of purulent contents when pressed.
Reaction to cold, hot, sour, sweet.
Discomfort while eating.
Visual enlargement of the tooth due to periodontal dystrophy.
Mobility and loosening of teeth - in a severe stage.

Treatment

Treatment of periodontal pockets is carried out in several ways. Which technique will be chosen depends on the depth of the lesion and the stage of the disease.

Laser cleaning

It is used at the first stage of pathology. Tartar is removed by the dental apparatus "Vector". High-frequency ultrasonic vibrations emitted by the scaler tip remove deposits located in periodontal pockets. In parallel, the gaps are disinfected and pathogenic microorganisms are eliminated.

Important! Laser cleaning is usually performed without anesthesia. The procedure is painless, some discomfort is possible. Anesthesia is used if the patient has hypersensitivity Or he is very afraid.

Photodynamic therapy

PDT is a modern non-surgical method of treating any stage of the disease. The pocket in the gum is cleaned of plaque and a special preparation is applied - concentrated chlorophyll. It is made from seaweed - spirullins. The substance contributes to the development of photosensitizers.

When exposed to a laser beam, an oxidative reaction begins with the release of oxygen. Microbes and bacteria die, and a protective layer forms on the mucosa. At the end of the procedure, the gum pockets are closed. Further therapy is aimed at restoring bone and granulation tissues.

curettage

The most common treatment. There are two types of procedure:

Open. It is carried out when the depth of the pockets does not exceed 5 mm.
Closed. It is used in the third stage of the lesion.

The general principle of both closed and open curettage is the same. The only difference is the excision of soft tissues. It is carried out with the second type of method.

The procedure consists of several stages:

Treatment of the oral cavity with antiseptic solutions: Chlorhexidine, Miramistin.
Anesthesia.
Mechanical removal of plaque, deposits, pus. If necessary, excision of the affected tissues.
Re-disinfection of mucous membranes.
Application of drugs that promote osseointegration - growth bone cells and gum healing.
Suturing (if there are incisions), applying a protective bandage.

Important! They usually prefer to open type curettage. It is more efficient and gives full access to gum pockets.

After the procedure starts recovery period. It lasts from 14 to 21 days. By the end of the third week, the connective tissues are completely restored.

Flap operation

Surgical intervention is carried out at the third stage of the disease, when the periodontal pocket has reached a depth of 5 or more millimeters. The operation is traumatic, painful, accompanied by physical and psychological discomfort. But it allows you to completely eliminate the lesions of connective tissues.

Procedure steps:

Anesthesia.
Vertical excision of the gums in two places.
Exfoliation of the periosteal flap.
Mechanical removal of affected tissues, dental deposits, pus.
Antiseptic treatment and application of wound healing drugs that stimulate the growth of new cells.
Suturing.

Important! As the anesthesia wears off, patients begin to feel pain. Therefore, after the operation, it is recommended to take painkillers.

During the rehabilitation period, wound healing gels are prescribed and antiseptic solutions for rinsing. Most often, Asepta, Metrogil Denta, Solcoseryl, Actovegin are prescribed. If the disease is accompanied by an extensive inflammatory and purulent process, antibiotics are indicated.

Prices

The cost of treating periodontal pockets depends on the type of procedure and the amount of treated area. Average prices for therapy:

- Processing with the “Vector” apparatus – 2,500 per jaw,
- Closed curettage - 1,400 per tooth,
- Open curettage - 2,700 per tooth,
- Flap surgery – From 2,500 to 3,500 depending on the number of roots in the tooth,
- PDT — 1,500 for one gingival pocket.

Periodontal pocket appears with the development of periodontitis. The disease is accompanied by pain, bleeding, and in advanced cases - a violation of interdental bonds and adentia. The treatment is carried out with the help of laser devices, mechanical cleaning and surgical excision.

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Treatment

A pocket on the gum is a reversible condition that can be cured proper hygiene. In case of a disease, for example, periodontal disease, treatment by a dentist will be required. Especially in the case of inflammation, soreness, swelling of the gums with the release of pus, a surgical operation can be used. Otherwise, it will lead to tooth loss.

With inflammation of the gum pocket, treatment is carried out different ways. Therapeutic methods are applied if the depth is not more than 4 mm. First of all, it is necessary to carry out cleaning of plaque, calculus, microbes, deposits, so that the neck closes, the attachment of the gums to the teeth is restored.

In case of bleeding, you should consult a doctor. Medical procedures are carried out with the help of:

hand tools;
ultrasonic scaler;
photosensitizer;
surgery.

The pocket area is cleaned with an ultrasonic sclera, then the surface of the tooth root is processed with polishing. Excess growths are removed from the inflamed tissue. Thus, conditions are provided for the restoration process for the normal attachment of the gums to the teeth.

Photodynamic therapy - a modern method by which an advanced form of the disease is treated without surgical intervention. The principle of the method is that after brushing the teeth, a special substance consisting of concentrated chlorophyll is applied to the surface of the gums.

It is obtained from spirullins - seaweed. In the destroyed, inflamed cells under the action of the drug, photosensitizers develop, and after that, after a certain period of time, the specialist applies a laser beam to the gums. Its light acts on photosensitizers with the release of oxygen. In this case, an active oxidative reaction occurs, as a result of which dies pathogenic flora and harmful bacteria. When the affected tissue areas in the periodontal pocket are removed, it closes completely. With the help of one procedure, you can completely cure the pocket and get rid of inflammation, bleeding. If the treatment is carried out with a laser, then a protective formation is created on the mucous membrane, preventing microbes from entering the gums, and also contributes to recovery. normal state pocket. After carrying out procedures to remove infected gum tissue, bone tissue should be restored. Successful therapy will be full recovery dentogingival connections and gum function.

For this, a patchwork technique is used, in which the gums are peeled off in the area of several teeth located nearby. Pockets are cleaned after opening manually, and then the root of the tooth is processed and the gum is sewn.

Such an operation is almost always carried out with a positive effect, but the only disadvantage of the procedure may be the difficulty in psychological aspect for the patient himself. You can consider the result of the operation of the tooth pocket, the photo of which is presented above.

Many patients are interested in how to treat a pocket in the gum between the teeth with curettage technology, which is often recommended by specialists. It is considered effective and less painful. Distinguish between open and closed way. During the procedure, gum pockets are thoroughly cleaned from deposits, tartar, and altered tissues.

The dentist prescribes a cleaning, taking into account the degree of the disease.

Closed curettage carried out by laser, ultrasound at a small depth of formation, not exceeding 5 mm.
Open curettage represents surgical operation which is carried out with the use of anesthetic drugs. In the process, an incision is made in the gums in the area of the interdental papillae, then cleaning is carried out and a means for effective healing after which the wound is sutured.

The result after curettage is noticeable after two weeks. Puffiness, redness, bleeding of the gums disappear, the depth of the pocket is reduced. To find out how to treat pockets in the gums, which method would be better, you need to seek advice from specialists at the first sign of the onset of the disease.

Preventive actions

To prevent re-treatment in the dental pocket, it is necessary to carry out preventive actions in a timely manner. When the curettage procedure is performed, the doctor prescribes a series preventive measures to be done regularly:

brushing teeth;
use cleaning products, pastes with an abrasive effect, where deposits are removed with the help of solid particles and polished teeth;
use floss ( dental floss) for cleaning between teeth;
preventive visit dental clinic at least twice a year;
compliance with additional recommendations of the doctor will reduce the growth of pockets, prevent complications of a different nature.

Treatment with folk remedies

Patients, when contacting a dentist, often ask if the dental pocket can be treated at home.

In this case, antiseptic solutions, decoctions from medicinal plants with a wound healing effect can effectively help. Several recipes can be found below.

Walnut. The recipe uses green peel. Grind a tablespoon of peel and pour olive oil in a warm state - 0.25 ml. Pour the product into a jar and close tightly, then refrigerate for a week with occasional shaking. After infusion, the resulting solution is filtered and the gums are lubricated five times during the day.
Plantain. Boiled water - 0.25 ml pour 20 grams of crushed plantain leaves and insist for at least an hour. They rinse the mouth four times throughout the day. In the summer, plantain juice helps a lot, for which the leaves are crushed in a blender and the juice is squeezed out with gauze. You can see the result of treatment with juice of gum pockets, the photo of which is presented below. A positive effect is achieved on the third day.
Eucalyptus oil. In 200 ml boiled water you need to add 2 teaspoons of oil, stir, then rinse at least three times a day for seven days. The tool is excellent for strengthening the gums.
Hydrogen peroxide. 1 teaspoon of peroxide is added to 100 ml of water. The mouth must be rinsed twice a day for a week.
Sugar beet. Grate the beets and wrap the resulting slurry in the amount of one teaspoon in cheesecloth, do not squeeze the juice. The remedy is applied for fifteen minutes to the inflamed areas. The procedure is carried out at least three times a day with a new compress. The expected result can come after two days of regular treatment.
Highlander kidney. With this tool, treatment is carried out for a week. A spoonful of highlander is poured with 0.25 ml of boiled water, then infused for 25 minutes. It is necessary to moisten a piece of cotton wool in the resulting tincture, apply to the inflamed area, hold for 10 minutes. The agent is applied twice a day. The infusion is applied hot, but not boiled.
Leaves and stems of golden mustache. The leaves of the plant are applied to the places of inflammation, and rinse the mouth with a tincture of the stems. One spoonful of the plant is brewed with half a liter of boiling water and infused for 30 minutes. Rinse is carried out at least three times a day.
Lemon peels. Brew chopped lemon peel with a glass of boiling water, leave for half an hour and rinse your mouth three times a day for ten days.
Air, propolis. The resulting remedy is effective for inflammation, as an anesthetic, wound healing. Preparation is carried out in advance with the addition of vodka. This will require one liter of vodka of the best quality, grind the root in an amount of 250 gr., And propolis - 20 gr. Each component is taken separately, poured with five hundred milliliters of vodka and infused for ten days with daily shaking. After preparation, proceed to treatment. The treatment is carried out over four weeks. To do this, mix calamus tincture with propolis tincture in a teaspoon.

In conclusion, it should be noted that self-treatment gum disease is not recommended without the advice of specialists. Desirable healing procedures perform in combination traditional methods with traditional medicine.

Gingival pocket (dental pocket, periodontal pocket)- the space formed due to the destruction of the dentogingival junction and the circular ligament of the tooth, as well as the resorption of bone tissue and the walls of the alveoli. The outer wall of the pocket and its bottom are lined with granulation tissue, covered and permeated with strands of stratified epithelium. Microorganisms, food debris accumulate in the periodontal pocket, big number destroyed leukocytes.

Elimination of periodontal pocket.

Medical treatment periodontal pocket cannot be considered an independent type of pocket treatment, since the epithelium vegetating along the periodontium is resistant to various kinds medicines. Medical treatment of the pocket, especially in moderate and severe periodontitis, is preparatory stage before surgery. To treat the pocket, you should use a 0.06% solution of chlorhexidine, for washing the pocket and instillation - 0.5% solution of metronidazole (suspension in a solution of chlorhexidine). These drugs act on the anaerobic flora of the pocket. Instead of these drugs, preparations of sanguirythrin, a herbal antibiotic, can be used. a wide range actions (1% liniment, 0.2% alcohol solution). Medical treatment should not take much time; usually 3-4 visits are required. All types of surgical interventions on the periodontium with periodontitis include the removal of subgingival tartar, microbial plaque, granulation tissue and vegetative epithelium, i.e. creation of conditions for secondary engraftment through the organization of a blood clot.

The choice of method of surgical treatment depends on the depth of the pocket.

So, with mild periodontitis(a pocket up to 3.5 mm deep) curettage is shown according to the generally accepted method, mainly in the area of the interdental space. At moderate periodontitis(pocket depth 4-5 mm) and, especially, severe (pocket more than 5 mm deep), it is not possible to carefully scrape out the periodontal pocket without visual control, therefore more complex operations with exfoliation of the mucoperiosteal flap are needed. Postoperative care consists in maintaining oral hygiene, examinations with antiseptic treatment oral mucosa. According to the indications, agents that stimulate healing, epithelization (solcoseryl ointment and jelly, actovegin, etc.) can be used.

A gingival pocket is a recess that separates the gum from the tooth. With a disease of periodontal tissues, it increases, due to which particles of food fall into the recess, soft plaque accumulates and tartar is deposited. These adverse factors cause inflammation of the gums and, if left untreated, lead to loosening and gradual loss of teeth. You can prevent their loss by seeking medical help in time.

Development of the pathological process

Normally, the pocket in the gum is deepened by no more than 3 mm. The small depth of the neck formed from soft tissues does not prevent its self-cleaning. Progressive deepening and inflammation of the gum pockets is a characteristic symptom of periodontal disease. The gum between the teeth swells, begins to hurt, and pus may appear from it. The initial stage of the development of the disease is gingivitis. At this stage, it is quite easy to remove inflammation - you need to carefully monitor oral hygiene, regularly undergo professional teeth cleaning with the removal of soft and hard plaque, rinse your mouth with antiseptics and herbal infusions.

Further development of the inflammatory process is accompanied by a significant increase in the number of bacteria. The enzymes secreted by them negatively affect the periodontal fibers, gradually causing their destruction. At this stage, the gum pockets undergo a series of changes and become periodontal. The activity of the inflammatory process increases, the soft tissues affected by it bleed when touched, erosion occurs on the gums.

The cavity between the tooth and the gum becomes deeper, the connective tissues that ensure the integrity of the dentition are affected by inflammation and weaken.

In the absence of treatment and cleaning of the gum pockets, the process will spread not only to the fibers of the periodontal ligaments, but also to the jaw bone tissue.

Receding gums lead to gradual exposure of the tooth. Destroyed tissues are not able to secure the top of the root in the hole and at some point it falls out.

At the initial stage of the disease, pockets in the gums are washed with an antibacterial agent once a year. In addition, daily application of drugs to the affected areas, rinsing the mouth with medicinal compositions is prescribed. In case of moderate periodontitis, the method of curettage is effective, in case of severe course of the disease, photodynamic, surgical methods and cable-stayed splinting are used.

Types of curettage, indications for the procedure

There are open and closed types of curettage. This technique provides effective removal of tartar, food debris, affected gum tissue and softened tooth cement. For closed curettage, a diode laser or an ultrasonic scaler is used. This method of treating pockets in the gums is used in cases where the depth of the cavity surrounding the tooth does not exceed 5 mm. The deepening is cleaned, the tooth root is processed and polished, the affected tissues are removed. This helps to restore the connection between teeth and gums.

Open curettage is a surgical intervention using local anesthesia. During the operation, the tissue in the area of the interdental papillae is dissected, the tartar is removed, the gingival pocket is thoroughly cleaned of deposits. Then a drug is applied that accelerates the growth of the epithelium and suppresses the vital activity of pathogenic microbes. The tooth root is polished for a tighter fit of the mucous membrane to it, and the wound is sutured. The rehabilitation period after the procedure is two weeks, after which patients report positive results - the gum does not bleed, does not hurt, hyperemia and swelling go away, the depth of the pocket decreases.

Indications for curettage are:

the depth of the pocket of exfoliated gingival tissue exceeds 3 mm;
accumulated a large amount of solid deposits;
the gum is affected by the inflammatory process.

Photodynamic method

A non-surgical way to treat an advanced or severe form of periodontal disease can be with the help of photodynamic therapy. Before the procedure, a professional cleaning of the oral cavity is performed, after which the gums are treated with chlorophyll obtained from spirulina algae. In response to its application, epithelial cells begin to produce photosensitizer substances. After 30 minutes, the doctor sends a laser beam to the diseased tissue. Its radiation leads to the decay of photosensitizers with the release of active oxygen.

Under the influence of the oxidative process, the microbes that caused inflammation are completely destroyed. The doctor removes damaged areas of tissue and closes the gum pocket. The advantage of this method of treatment: sparing, painless effect and high efficiency - a single procedure is enough to eliminate inflammation and bleeding. A film is formed on the gums that prevents the penetration of infection and the recurrence of the disease. The use of osteogenic preparations and amino acids helps to restore the affected tissues.

Cable-stayed splinting

At the initial stage of periodontitis, to improve the condition of the gums, you can use preparations made from herbal ingredients according to traditional medicine recipes. They inhibit bacteria and improve wound healing. Additionally, it is useful to massage the gums with a soft-bristled toothbrush, followed by rinsing the mouth with infusions of chamomile, oak bark or sage.

A good therapeutic effect is provided by the following means:

Peel of unripe walnuts infused with olive oil (1 tablespoon per 250 ml). For infusion, the mixture should be placed in the refrigerator. Periodically you need to get a jar and shake it. After a week, strain and use to lubricate the gums 3-5 times a day.
Infusion or juice of plantain. To prepare the infusion, pour 20 g of leaves with a glass of boiling water. Use for mouthwash. The juice squeezed from the fresh leaves of the plant is applied to the diseased areas of the gums 3 times a day.
Compresses from grated fresh beets. The mass, without squeezing, is wrapped in gauze and kept on the gum for 15 minutes. Frequency of use - 3 times a day.
Infusion of grass highlander kidney. Pour a spoonful of crushed vegetative parts of the plant with a glass of boiling water. Let it brew for 15 min. Use 2 times a day, applying tampons moistened with warm infusion to the gums.
Gruel from crushed sea buckthorn berries. Wrap the mass of fruits in a two-layer piece of gauze and apply to diseased areas 2 times a day for 20 minutes.
Tincture of viburnum fruits with honey. It is necessary to mix 500 g of berries with the same amount of buckwheat honey and 500 ml of 70% ethyl (medical) alcohol. Put in a dark place for 2 weeks. How to use: 1 tbsp. l. 3-4 times a day for 20 minutes. before meals. Taking the remedy helps to strengthen the immune system and cure periodontal disease. Additionally, cotton swabs moistened with tincture can be applied to the gums.

Prevention of the development of periodontal disease

Prevent gum inflammation and deepening of gum pockets regular cleaning teeth, rinsing the mouth after each meal, using floss (special thread) to clean the interdental gaps. Periodically, but not constantly, pastes containing abrasives should be used to remove hard deposits. High-quality removal of tartar will provide professional teeth cleaning using ultrasound.

For timely detection and elimination of emerging in the oral cavity pathological processes It is recommended to visit the dentist 2 times a year.

Treatment of periodontal pocket depends on the degree of development of the disease. If the process has just begun, and the tissues have not started, prescribe conservative therapy for the underlying disease. For example, with periodontal disease (non-inflammatory systemic damage to the periodontal tissues), whole complex medical measures. They include the removal of plaque and deposits using ultrasound. After that, anti-inflammatory drug therapy is prescribed. The course of treatment may include antiseptic rinsing of the mouth and applying a special gel to the inflamed gums. In moderate to severe periodontal disease, antibiotics are additionally prescribed. After the course of treatment, it is necessary to constantly observe thorough oral hygiene.

For successful treatment periodontitis and periodontal pockets, the oral cavity should be sanitized, that is, teeth affected by caries should be cured or removed.

Later, when dangerous symptoms such as blood while brushing your teeth, pain and burning sensation in your teeth, you should contact your dentist for advice. The cause of the disease of the periodontal tissues can also be an unsuccessful form artificial crown. After its adjustment and a set of measures aimed at eliminating inflammation, it will stop.

Curettage - a surgical method for the treatment of periodontal pockets

With a far advanced process, the periodontal pocket follows with the help of a surgical intervention, which is curettage. It is prescribed if the pathological depth of the periodontal pocket is more than 3 mm, if there is inflammation of the gums, abundant deposits of tartar and plaque. Depending on the depth of periodontal pockets and the nature of the procedure, there are 2 types of procedures: closed and open curettage.

Closed curettage is used if the depth of periodontal pockets is up to five millimeters. In this case, the procedure is performed without cutting the gums and includes the following steps:
- gum condition
- performing local anesthesia,
- cleaning of periodontal pockets with special instruments without damaging the gum tissue,
- polishing of tooth roots.
Closed curettage completely closes small periodontal pockets and effectively reduces deep ones.

If closed curettage was not very effective or in the case when the depth pathological pockets turned out to be over 5 mm, open curettage is performed. In this case, a surgical dissection of the gums is performed, the operation includes the following steps:
- diagnosis of the condition of the gums,
- local,
- cutting the gums to access the base of periodontal pockets (flap surgery),
- cleaning of pathological pockets with special tools,
- application of osteogenic preparations to the damaged part to stimulate the growth of bone tissue,
- suturing gums.

One and a half to two months after the operation, a second dental examination is performed to determine the effectiveness of the treatment.

If the tissues holding the tooth are damaged during the operation, bone grafting can be performed. It allows you to fix the tooth in the hole, promotes further recovery the forces of the body.